Public hospital management shake-up only way to reverse slide
Action is needed on Tasmania’s health system right now,
WHEREVER you go in this country, public hospitals are in trouble. There are too many patients, not enough staff, not enough beds, not enough money.
Doctors and nurses know they can’t treat everyone as well as they ought to be treated. Patients suffer avoidable illness and, occasionally, avoidable death.
When we compare the Tasmanian experience with the national average, that is not a high benchmark to meet. But on almost every measure, this state’s public hospital system remains the worst in the country.
Because we have the nation’s oldest, sickest and poorest population, we need more public hospital care than other Australians. The Commonwealth Grants Commission knows this and this year is redistributing $263 million in GST away from other states and giving it to us.
Every five years, the commission examines each state’s relative needs and produces a formula that it uses to pay our state government to bring our hospital system up to the level at which it can provide national-standard care to our much needier population. And we can use those formulas to work out what particular resources our hospitals need, and which our government is paid to provide.
But the figures show those resources are not being provided.
Taking the Grants Commission’s weighting into account, the rate of patient days — one inpatient for a day equals one patient day — in Tasmanian hospitals was 22 per cent less in 2015-16 than in the nation as a whole.
The number of inpatients was 36 per cent lower. Our emergency departments are more crowded than those in other states. Even two years ago, the number of patients being kept on trolleys in emergency because no beds are available on the wards was already twice as bad statewide than elsewhere.
At the Royal Hobart Hospital it is worse still.
Measures of safety and quality show us, overall, near the bottom of the heap.
Right now, we have about 200 fewer beds than we need to provide national-standard care.
The list goes on. But the important question now is not what’s happening, we all know that, but how we can fix it.
A group of health organisations has developed a detailed plan to put us on the right track within four years — a single parliamentary term. It won’t get us all the way to where we need to be but it will turn the system around.
The state’s two major hospitals need many more beds as soon as possible. At least 80 per cent of these should be top-level acute beds. There is space for some of those in Launceston immediately but the major expansion at the Royal Hobart Hospital will have to wait until the rebuild is complete in two years.
No matter what anyone now does, the Hobart crisis will continue until then. But as soon as the new wards are finished the government must be ready to fill them with patients.
That means staff — not
only more doctors and nurses but more allied health professionals, ward clerks, ambulance paramedics, computer personnel, cooks and cleaners. The notion that some staff are non-frontline is a damaging nonsense. A functioning hospital needs adequate staff at all levels.
Somehow, somewhere, an extra 10 properly equipped psychiatric beds must be found right now at the Royal Hobart Hospital to ease the unsafe chaos in that area.
We must start to fix our creaking computer systems so hospital staff and GPs can find out what’s going on with their patients. Administration needs a shake-up. The central micromanaging of small details must stop. When a nurse or cleaner resigns it should not take months to get permission to replace them.
Relationships between staff and many of the state’s top administrators have broken down irretrievably. It seems inevitable that some executives will have to go: trust in them no longer exists.
Health administration does not need yet another wholesale reorganisation. But day-to-day management decisions need to be taken by the CEOs of each major hospital. The central Tasmanian Health Service should be responsible for policy, oversight and standards.
Right now, nobody can tell you how many staff positions are currently authorised or where they are. That should be public information. We will then be able to measure staff levels in every area against national and international best practice.
Planning needs to start immediately for new building works in the state’s two main hospitals. In Launceston, it can no longer be put off. And increasing demand means the new Hobart buildings will be full within five or six years.
At current rates of increasing patient numbers, Tasmania needs an extra 50 beds every year. Even if an extra 200 beds are provided within the next four-year parliamentary term — and recruitment difficulties will probably limit it to that — we will by then need as many again.
But we would — at last — be on the right track.